If you have indeed felt chest palpitations but are well enough to sit at the computer and read about them, you're probably wondering: Were they a scary type of arrhythmia or just a normal skipping of the beat? What caused it, and what should you do about it?
The evaluation of palpitations starts with a visit to your doctor. Be prepared to go over a history of your other medical problems and review a lengthy list of other symptoms that may not even seem related. For instance, diarrhea can signal an electrolyte imbalance or excessive levels of thyroid hormone in your blood. Another greatly important discussion is a review of your medication use, including prescriptions, supplements like herbs, over-the-counter drugs, and any illicit drugs. Diet aids, decongestants, energy supplements, and cocaine are classic contributors to palpitations.
Along those lines, consider whether you've been getting less sleep and possibly drinking more caffeine-rich beverages to stay awake. Caffeine is a stimulant like the drugs listed above. Also, both high stress and anxiety can interfere with sleep and encourage more frequent palpitations.
During your examination, the doctor is going to evaluate your pulse, typically at the wrist, for a minute or so, to get a sense of whether the pulse is coming at expected intervals, referred to as regular, or variable intervals, and so called irregular. Blood pressure will be taken as well. You will also likely have your thyroid-the gland at the base of your neck-examined, to gauge its size and to assess whether any nodules are present. A basic assessment of your muscle strength and reflexes will usually be done, too. Last, the doctor will listen to your heart carefully for murmurs, which are caused by the sound of the blood flowing within and across the valves of the heart.
A typical evaluation will likely continue with an EKG, which is a tracing of the electrical activity within the heart that correlates to the contraction of the heart muscle and the resulting pumping action. An EKG is an excellent way to detect frequent, abnormal rhythms, and it provides clues to any predisposing abnormalities that may indicate a serious risk of dangerous arrhythmias.
But here's a downside: the EKG only traces the heartbeat for 1 to 2 minutes - often that's not enough time for it to detect the infrequent strange beats you've been feeling. If you've been having infrequent but severe palpitations, you may be asked to wear a portable EKG device called a Holter monitor for 24 hours (or even for 30 days), to detect infrequent heart-rhythm abnormalities. In the event of symptoms, the wearer is typically required to press a button on the monitor so these EKG tracings can be recorded over such long time periods.
Blood work may be another step in the evaluation of palpitations, depending on the other symptoms you suffer and the findings of your examination. Most importantly, tests that verify normal electrolytes in the blood, including potassium, calcium, and magnesium, as well as a simple test to determine the activity of your thyroid gland, should be done.
In the event that the doctor heard any abnormal sounds while listening to your heart with a stethoscope, you may be sent to the cardiology department next for an echocardiogram. This is a painless test that uses ultrasound to record a moving picture, in real time, of the shape and movement of your heart chambers and valves.
At the end of all this testing you hopefully will have an answer as to what is causing your palpitations. But if the cause remains a mystery, you should still be able to rest easier, knowing that a thorough evaluation was unable to turn up any worrisome findings. Typically, the anxiety-provoked by palpitations lessens once you learn that everything is OK. And the palpitations themselves tend to occur less frequently once your heightened awareness of them lessens.
